Can risk factor screening predict hepatitis C antibody reactivity?

Risk factors for hepatitis C infection among sexually transmitted disease-infected, inner city obstetric patients

Objective: To test the hypothesis that our inner city obstetric patients who have been infected with sexually transmitted diseases (STDs) will have a higher prevalence of hepatitis C virus infection than the general population and to identify specific risk factors and high-risk groups.

Methods: All patients in our prenatal clinic (July 1997–April 1999) who tested positive for one or more STDs were asked to return for hepatitis C antibody testing. Medical charts of all patients who returned for hepatitis C testing were reviewed.

Results: A total of 106 patients with STDs were tested for hepatitis C. Positive screening tests for anti-hepatitis C antibody were found in 6.6% (7/106) of the patients (95% CI = 2.7–13.1%). This frequency is significantly higher than the hepatitis C prevalence (1.8%) in the general United States population (p = 0.006). Multiple logistic regression analysis confirmed only older age (p = 0.016) and positive HIV status (p = 0.023) to be significant predictors of hepatitis C infection.

Conclusions: Inner city STD-infected obstetric patients are at high risk for hepatitis C infection compared with the general population. Increasing age and HIV-positive status are risk factors which are significantly associated with hepatitis C infection.

Hepatitis C risk factors in Iranian volunteer blood donors: a case-control study

BACKGROUND

In order to evaluate some possible risk factors for the spread of hepatitis C infection a case-control study was undertaken.

METHODS

The study population consisted of first time blood donors referred to the Iranian Blood Transfusion Organization. Enzyme-linked immunosorbent assay and recombinant immunoblot assay anti-hepatitis C virus (HCV) tests were performed for all samples. Risk factors were evaluated using a questionnaire. A stepwise forward logistic regression analysis was used.

RESULTS

The case group consisted of 193 HCV-positive donors, and 196 HCV-negative donors comprised the control group. Transfusion, undergoing endoscopy, extramarital sexual activities, non-intravenous (i.v.) drug abuse, i.v. drug abuse, and receiving wounds at war were found to be independent risk factors of being HCV-positive (Odds ratio: 17, 4, 42.2, 34.4, 52.8 and 5.2, respectively). No apparent risk factors could be demonstrated in 24.5% of the positive cases.

CONCLUSION

This study could be of particular interest because of the low seroprevalence of hepatitis C and the religious culture of the study population. There are certain medical procedures, lifestyle patterns, and customs and cultural matters in Iran that predispose people to a number of HCV risk factors.

Prevalence of hepatitis C infection among general practice patients in the Lyon area, France

STUDY OBJECTIVE

To estimate the prevalence of hepatitis C virus (HCV) infection among patients in general practices.

DESIGN AND PARTICIPANTS

A screening campaign requested by the French Health Insurance Fund and involving 271 general practitioners (GPs) and 96% of the 95 medical laboratories was conducted in the Lyon area. Each GP participated for one week and offered an HCV screening to all patients aged 18-69 years during this period. Risk factors were estimated by a medical questionnaire (MQ) filled in by the physician.

MAIN RESULTS

From May to October 1997, 11,805 subjects were recruited into the study. Among them, 101 were known HCV positive. The MQ was filled up in 86% of the 11,704 remaining patients. Only 59% of those (6876/11,704) went to a laboratory to be tested. Fifty-one were ELISA positive of whom 30 were confirmed by RIBA or PCR. If we add 101 patients that were known HCV positive and estimate the prevalence among patients who did not go to the laboratory, this study gives a total estimated prevalence of 1.3%.

CONCLUSIONS

The prevalence of HCV infection among patients of GPs is about 1.3%, very close to the estimate in the French general population. The substantial number of patients known HCV positive is probably related to the participation of GPs sensitised to HCV issues and who already have screened most of their HCV patients.

Do undefined sources of hepatitis C transmission exist? The Greek study in General Practice

A seroepidemiological study was carried out in 15 primary health care (PHC) centres in rural Greece to determine the prevalence of hepatitis C virus (HCV) in the surgeries of Greek General Practitioners (GPs) and to further clarify the transmission of hepatitis C in Greece. Serum samples were obtained from 1961 subjects (1259 females) aged >/= 15 years, who visited GP surgeries between July 1996 and February 1997 in 15 PHC centres located in three large Greek regions (Macedonia, Attika and Crete). Subjects who participated in the study fulfilled the following criteria: history of blood transfusion; hospital admission of > 7 days' duration without surgical or other intervention; use of intravenous drugs (current or previous); or women with a history of medical or paramedical abortion. Nearly 65% (1263 subjects) of the participants in this study reported hospital admission with a length of stay > 7 days. Antibodies to HCV (anti-HCV) were found in 67 participants (3. 5%), 41 of whom were females and 44 of whom were aged >/= 61 years. The highest prevalence (4.8%) of anti-HCV was found in Crete, and differences among the Greek regions were statistically significant (P < 0.05). Multivariate statistical analysis showed that in addition to regional differences, the following variables had a statistically significant effect on the prevalence of anti-HCV: history of dental surgery; use of intravenous drugs; hospital admission for > 7 days; and the high consumption of alcoholic drinks. Hence there is a significant variability in the prevalence of hepatitis C in well-defined PHC areas of Greece. Several risk factors for acquiring HCV infection have been identified. Screening for HCV risk factors may enable Greek GPs to identify HCV-infected patients.